Are there occasions in which an oncologist would retry the same chemo as before? - 1255783

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shinbo
Are there occasions in which an oncologist would retry the same chemo as before? - 1255783

I don't want to be too specific as to follow the rules of the forum, but are there occasions where Oncologist would retry the same chemo combinations added a extra agent like Avastin that was not given before? Or once a combination of chemo is given, its normal to give an entire new combo of chemo?

Thank you

Daniel

Dr West
Reply To: Are there occasions in which an oncologist would retry

The general rule is that we don't typically return to an agent or combination that was used previously, typically maxxing out at 4-6 cycles of a chemo drug. But some agents are so well tolerated and potentially effective that it seems that stopping after a fixed number of cycles may be artificially limiting the potential benefit. Accordingly, if someone hasn't actually progressed on a prior therapy -- if they came off because of tolerability concerns or just because they completed 4 cycles, I think it makes sense to consider returning to that agent, particularly if there aren't other agents that have an anticipated survival benefit that haven't been tried already.

With regard to the question of whether a combination or single agent would be used, only single agents have a demonstrated benefit in previously treated patients, and my practice has been to not favor combinations, but rather sequential single agent approaches. However, it's fair to say that there isn't enough evidence on this question to say anything definitive about returning to a single agent or a combination, except that we tend to see increasing incremental side effects exceed incremental benefits when combinations are used beyond about 4-6 cycles.

-Dr. West

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Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education